Cost-Effectiveness of Routine Outpatient Follow-Up Intervals in Adults with Sickle Cell Anemia: A Pilot Study from Cameroon

Abstract

Background: Sickle cell disease (SCD) requires lifelong management and monitoring, yet in Cameroon, many adults seek care only during crisis, driving hospitalizations and healthcare costs. This study examined whether adults with sickle cell anemia (SCA) attending ≥3 routine follow-ups annually (≤4 months apart) had lower cost per gain in hospital-free days (HFDs) and painful episodes averted compared to those with fewer or no visits. Methods: A cost-effectiveness analysis was conducted using retrospective data from 51 patients at Yaoundé Central Hospital. Patients were grouped by follow-up frequency (≥3, 1–2, or none per year). Outcomes included HFDs (primary) and mild-to-severe painful episodes (secondary) over 3 months. Costs, mainly out-of-pocket, comprised consultations, hospital stays, laboratory/imaging tests, consumables, medications, and blood products. Genetic matching with covariate balancing propensity scores were applied to reduce selection bias. Mean costs and effectiveness were estimated through regression methods, with uncertainties assessed using bias-corrected and accelerated (BCa) bootstrap intervals. Results: Three or more routine follow-ups per year were associated with lower costs and improved outcomes. Compared with no follow-ups, the discounted incremental-cost effectiveness ratio (ICER) was –XAF 88,409.12 (95% CI, –XAF 115,552.60 to –XAF 26,256.74) per HFD, indicating dominance. Versus 1–2 follow-ups per year, the ICER was –XAF 198,231.49 (95% CI, –XAF 446,763.70 to XAF 152,199.10) per HFDs, also suggesting dominance, though Bca bootstrap intervals revealed substantial uncertainty. Conclusion: Routine follow-up (≥3 per year) for SCA complication monitoring was less costly and yielded more HFDs and fewer painful episodes than no follow-up. Compared with 1–2 follow visits, costs were lower but gains in HFDs and reductions in painful episodes were not significant, reflected in wide confidence intervals. Policies encouraging ≥3 annual follow-ups may reduce the clinical, financial, and psychological burden of SCA on patients, families, and the health system. The certainty of these findings is limited by the small sample size and the short duration (three months) of the retrospective outcome data.